More about trauma – PTSD and Chronic Traumatisation

1. PTSD (Posttraumatic Stress Disorder)Usually the mind/body system processes and integrates life's experiences, whatever comes along. The mind has a tendency towards healthy self-organisation of experience.Occasionally this self-healing mechanism is overwhelmed, and the disturbing experiences that have led to that overwhelm are stored in a dysfunctional way. It is as if they are frozen in time and have a life of their own causing various symptoms that are either there all the time or can easily be triggered by reminders of the experience. The day-to-day part of the self attempting to get on with life as normal, tries to prevent the resulting disturbing intrusions into consciousness from occurring by avoiding thinking about it, or by avoiding being in similar situations. For instance, someone who may have had an accident while driving, may make long detours to avoid driving in the place where the accident happened.

What is posttraumatic stress disorder?

Posttraumatic stress is a natural human reaction to extreme stress. A traumatic event is a shock to the whole body/mind system which can overwhelm the mind's processing system, leaving the symptoms unresolved and as if they are fixed in time. It can be very incapacitating and distressing. Developing symptoms of PTSD can happen to anyone, but fortunately there are very effective treatments available now which enable the mind's natural healing processing of the event to take place and then eliminate the symptoms, usually completely.Posttraumatic stress disorder (PTSD) has a characteristic set of symptoms and for the diagnosis of PTSD, the symptoms will have lasted for over one month.

Examples of extreme stressors include events such as:

Serious accident or natural disaster

Rape or criminal assault

Combat exposure

Child sexual or physical abuse or severe neglect

Hostage / imprisonment / torture / displacement as refugee

Witnessing a traumatic event

Sudden unexpected death of a loved one

Events in which one feels in extreme danger with the fear (even momentarily) that one is going to die.

Very sudden completely unexpected traumas such as being hit by a car from behind, even though the accident may objectively not seem too serious, can lead to PTSD.

A person with PTSD has three main types of symptoms:

Reexperience of the traumatic event as indicated by:

Intrusive distressing recollections of the event

Flashbacks (feeling as if the event were recurring while awake)

Nightmares (the event or other frightening images recur frequently in dreams)

Exaggerated emotional and physical reactions to triggers that remind the person of the event

Avoidance and emotional numbing as indicated by:

Extensive avoidance of activities, places, thoughts, feelings, or conversations relating to the trauma.

Loss of interest

Feeling detached from others

Restricted emotions

Increased arousal as indicated by :

Difficulty sleeping

Instability or outbursts of anger

Difficulty concentrating

Hypervigilance

An exaggerated startle response

Other problems that can be associated with PTSD:

Panic attacks

Depression

Severe avoidant behaviour to the point of being housebound

Suicidal thoughts and feelings

Substance abuse

Feeling of alienation and isolation

Feelings of mistrust and betrayal

Anger and irritability

Severe impairment in daily functioning

Physical pain and/or strange body sensations that do not have a known physical cause

Headaches

An example of the effects of a trauma that has not settled by itself.

MrHope was driving his car on his usual route to work, when a car suddenly coming out of a side turning without stopping crashed into his near-side, causing a violent jolt to his body as well as severe damage to his car. The accident happened a year ago, and Mr Hope feels that he has life has changed severely for the worse since then.

He continues to have severe pain in his neck and shoulder despite having medical investigations which failed to show signs of an injury, and having physiotherapy for three months. He copes by taking large quantities of pain killers.

He finds himself snappy and irritable with his family and work colleagues.

He does not sleep well any more, and finds it hard to relax in any situation.

He has an ongoing sense that something bad is going to happen, feeling jittery or agitated.

He has lost his motivation and enjoyment of life, is not interested in watching football or going out with his mates, instead drinking on his own at home.

He feels isolated and a bit unreal.

He refuses to talk about the accident and has found reminders of it, even such as dealing with insurance claim forms extremely stressful.

He sometimes has flashbacks of the accident.

He has found another route to work so he can avoid the place where the accident happened but even so, jumps a mile when he sees a car approaching a junction just as he is about to drive past it.

Mr Hope's symptoms indicate that he has posttraumatic stress disorder. It is also quite likely that the physical pain that is not getting any better is a 'frozen in time' non-integrated aspect of the experience which the body/mind system could not process at the time, because for minutes, hours or days after the accident, he was still in a state of shock and his mind in overwhelm. He may well not have been aware of the pain for a few hours or even for a day or two after the accident.

Chronic traumatisation

This is the result of a prolonged period where the person has been subject to a severe, repeated life-threatening situation, or one that is perceived as life-threatening. It is more complex when the threat is coming from people (rather than other dangerous circumstances), and even more complex when there has been neglect and a lack of a sense of safety in childhood, and where perpetrators are those who should be trusted to take care of one, such as in child sexual abuse where a parent is involved.

There are various degrees of complexity of the symptoms involved in this, as well as those mentioned for PTSD, including dissociative disorders, problems with sense of identity, phobias, a sense of internal chaos, somatic disorders and general health problems, some which may seem to have no physical cause in the present. There are also likely to be problems with relationships. Where the trauma has occurred in childhood, the adult may be highly functioning, having unconsciously screened off the memories and become adapted to the effects of them. All of this can break through at any time in life, when triggered by some other crisis, or just out of the blue, with devastating effects, and need highly specialised treatment.